scholarly journals The U.S. Needs a National Human Health Observing System

2021 ◽  
Vol 9 ◽  
Author(s):  
Paul A. Sandifer ◽  
Burton H. Singer ◽  
Rita R. Colwell

The COVID-19 pandemic and increasing frequency and severity of environmental disasters reveal an urgent need for a robust health observing/surveillance system. With the possible exception of Brazil, we know of no such comprehensive health observing capacity. The US should create a national system of linked regionally-based health monitoring systems similar to those for weather, ocean conditions, and climate. Like those for weather, the health observing system should operate continuously, collecting mental, physical, and community health data before, during, and after events. The system should include existing cross-sectional health data surveys, along with significant new investment in regional longitudinal cohort studies. The recently described framework for a Gulf of Mexico Community Health Observing System is suggested as a potential model for development of a nation-wide system.

2021 ◽  
Author(s):  
Maria Sääskilahti ◽  
Anna Ojanen ◽  
Riitta Ahonen ◽  
Johanna Timonen

BACKGROUND Patient engagement is a worldwide trend in health care. Patient portals have the potential to increase patients’ knowledge about their health and care and therefore enhance patient engagement. Portal users’ experiences are needed to determine if these portals work appropriately and if there are barriers to achieving the aims that were set before their implementation. OBJECTIVE The aim of this study is to analyze pharmacy customers’ experiences of the Finnish nationwide patient portal My Kanta in terms of benefits, problems, and potential improvements. METHODS A questionnaire survey was conducted among pharmacy customers in the spring of 2019. The questionnaires (N=2866) were distributed from 18 community pharmacies across mainland Finland to customers aged ≥18 years who were purchasing prescription medicines for themselves or their children aged <18 years. Using open-ended questions, customers were asked about their experiences of the benefits and problems of My Kanta and what improvements could be made. Their responses were encoded and categorized using inductive content analysis, stored in SPSS Statistics for Windows, and analyzed using frequencies. RESULTS Of the 2866 questionnaires, a total of 994 (34.68%) questionnaires were included in the analysis. Most respondents were My Kanta users (820/994, 82.5%); of these 820 users, 667 (81.3%) reported at least one benefit, 311 (37.9%) reported at least one problem, and 327 (39.9%) reported at least one potential improvement when using My Kanta. The most commonly mentioned benefits were opportunities to view health data (290/667, 43.5%) and prescriptions (247/667, 37%) and to renew prescriptions (220/667, 33%). The most extensively reported problems with My Kanta were that the portal lacks health data (71/311, 22.8%), navigating the service and searching for information is difficult (68/311, 21.9%), and the delay before health data are incorporated into the service (41/311, 13.2%). The most frequently suggested potential improvements were that My Kanta needs more comprehensive health data (89/327, 27.2%); the service should be easier to navigate and information easier to access (71/327, 21.7%); the service should have more functions (51/327, 15.6%); and health data should be entered into the portal more promptly (47/327, 14.4%). CONCLUSIONS Pharmacy customers reported more benefits than problems or potential improvements regarding the use of My Kanta. The service is useful for viewing health data and prescriptions and for renewing prescriptions. However, portal users would like to see more data and functions available in the portal and data searches to be made easier. These improvements could make the data and functions provided by the portal easier to view and use and hence promote patient engagement.


10.2196/31483 ◽  
2021 ◽  
Vol 23 (11) ◽  
pp. e31483
Author(s):  
Maria Sääskilahti ◽  
Anna Ojanen ◽  
Riitta Ahonen ◽  
Johanna Timonen

Background Patient engagement is a worldwide trend in health care. Patient portals have the potential to increase patients’ knowledge about their health and care and therefore enhance patient engagement. Portal users’ experiences are needed to determine if these portals work appropriately and if there are barriers to achieving the aims that were set before their implementation. Objective The aim of this study is to analyze pharmacy customers’ experiences of the Finnish nationwide patient portal My Kanta in terms of benefits, problems, and potential improvements. Methods A questionnaire survey was conducted among pharmacy customers in the spring of 2019. The questionnaires (N=2866) were distributed from 18 community pharmacies across mainland Finland to customers aged ≥18 years who were purchasing prescription medicines for themselves or their children aged <18 years. Using open-ended questions, customers were asked about their experiences of the benefits and problems of My Kanta and what improvements could be made. Their responses were encoded and categorized using inductive content analysis, stored in SPSS Statistics for Windows, and analyzed using frequencies. Results Of the 2866 questionnaires, a total of 994 (34.68%) questionnaires were included in the analysis. Most respondents were My Kanta users (820/994, 82.5%); of these 820 users, 667 (81.3%) reported at least one benefit, 311 (37.9%) reported at least one problem, and 327 (39.9%) reported at least one potential improvement when using My Kanta. The most commonly mentioned benefits were opportunities to view health data (290/667, 43.5%) and prescriptions (247/667, 37%) and to renew prescriptions (220/667, 33%). The most extensively reported problems with My Kanta were that the portal lacks health data (71/311, 22.8%), navigating the service and searching for information is difficult (68/311, 21.9%), and the delay before health data are incorporated into the service (41/311, 13.2%). The most frequently suggested potential improvements were that My Kanta needs more comprehensive health data (89/327, 27.2%); the service should be easier to navigate and information easier to access (71/327, 21.7%); the service should have more functions (51/327, 15.6%); and health data should be entered into the portal more promptly (47/327, 14.4%). Conclusions Pharmacy customers reported more benefits than problems or potential improvements regarding the use of My Kanta. The service is useful for viewing health data and prescriptions and for renewing prescriptions. However, portal users would like to see more data and functions available in the portal and data searches to be made easier. These improvements could make the data and functions provided by the portal easier to view and use and hence promote patient engagement.


2018 ◽  
Vol 6 (1) ◽  
pp. 14
Author(s):  
Harsono . ◽  
Bagoes Widjanarko ◽  
Priyadi Nugraha Prabamurti

Penerapan perilaku hidup bersih dan sehat pada tatanan rumah tangga di Indonesia pada tahun 2015, baru mencapai 55%. Padahal dari sisi perilaku per indikator idealnya diatas 80%. Faktor risiko timbulnya Penyakit Tidak Menular(PTM) antara lain karena gaya hidup seperti merokok, obesitas, inaktivitas, peminum alcohol dan narkoba. Lemahnya upaya preventif dan promotif dalam upaya kesehatan masyarakat (UKM) disebabkan salah satunya oleh distribusi tenaga promotif preventif di Puskesmas masih belum merata.. Keberadaan tenaga kontrak Promotor Kesehatan di Puskesmas diharapkan mampu menjawab kekurangan tenaga promotif preventif di Kabupaten Indramayu. Namun keberadaan mereka menjadi prokontra sehingga dapat berpengaruh pada kinerja dalam pelayanan promosi kesehatan di Puskesmas.Penelitian ini bertujuan untuk menganalisis faktor-faktor yang mempengaruhi kinerja tenaga kontrak promotor kesehatan dalam pelayanan promosi kesehatan Puskesmas di Kabupaten Indramayu. Jenis penelitian ini menggunakan pendekatan kuantitatif dengan rancangan studi cross sectional. Besar sampel adalah 35 orang. Analisis data secara univariat, bivariat dengan Chi square dan multivariat dengan regresi logistik. Hasil penelitian ini menunjukan bahwa kinerja tenaga kontrak promotor kesehatan dalam pelayanan promosi kesehatan Puskesmas di Kabupaten Indramayu sebagian besar responden berkinerja tinggi (51,4%). Hasil uji statistic menunjukan bahwa terdapat hubungan antara pengetahuan (p=000), kemampuan diri (p=0,000), persepsi beban kerja (p=0,011), motivasi (p=0,010), imbalan (p=0,024) dan sarana prasarana (p=0,001) dengan kinerja tenaga kontrak promotor kesehatan dalam pelayanan promosi kesehatan Puskesmas di Kabupaten Indramayu. Faktor yang memiliki pengaruh paling kuat terhadap kinerja tenaga kontrak promotor kesehatan adalah faktor pengetahuan dengan nilai Odds Ratio (OR=17,84 95% CI=1,99-149,5) dan kemampuan diri (OR=17,36 95% CI=1,4-220). Rekomendasi pada penelitian ini adalah perlu adanya pelatihan e-learning dan in-house training, pembinaan tenaga kontrak, dan penyediaan sarana prasarana promosi kesehatan. Abstract The application of clean and healthy life behavior at household order in Indonesia in 2015, had just reached 55%. From the behavior side, where every indicator should be above 80% as the ideal one. The weakness of preventive and promotion effort in accordance with the community health efforts, one of the reasons is because the distribution of the health preventive and promotion agent into the community health centre is not all totally covered yet. The presence of the out-sourcing health promoter agent in the community’s health center is expected to be able to supply the lack of health preventive and promotion agent in Indramayu. However, their presence become pros and cons, which can influence to the performance in theservice of health promotion in community’s health centre. This research aimed to analyze the elements which influence their performance to carry out health promotion service in every community’s health centre in Indramayu. Type of observational study with cross sectional design.The population in this study amounted to 105 people, consisting of 35 contract workers, 35 heads of Puskesmas, and 35 co-workers contract workers.The sampling technique is purposive sampling in total population or saturated sampling, so the same sample size is 105 people. The data are analyzed by univariat, bivariat method with Chi square and multivariate with logistic regression. The results of this study indicate that the performance of health promotion contract workers in health promotion service of Puskesmas in Indramayu Regency most of the respondents are high performers (51.4%). Based on the test of Chi-Square, it shows that the elements related to the out-sourcing health promoter in carrying out the health champagne service at community’s health centre in Indramayu are knowledge (score p=000), self ability (p=0,000), duty perception (p=0,011), motivation (p=0,010), reward (p=0,024), means and infrastructures (0,001). The most influence factors to the performance to the out-sourcing health promoter in carrying out the health champagne service at community’s health centre are knowledge factor (p=0,009) with the OR score=17,84 95% CI=1,99-149,5.Therefore, as the recommendation, the training for the candidates of health promoters, e-learning, in-house training, and also the out-sourcing coaching as well, and providing means and infrastructures of health promotion.


2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Erike Yunicha Viridula

ABSTRAKGangguan pertumbuhan bayi pada usia dini menyebabkan bayi diberikan MP-ASI terlalu dini dan ibunya tidak memberikan ASI eksklusif selama 6 bulan pada awal kehidupan bayi. Dari hasil studi pendahuluan pada bayi berusia 6-11 bulan yang mendapatkan ASI eksklusif hampir sepenuhnya meragukan perkembangan. Jika ini terus berlanjut, bayi tidak dapat berkembang dengan baik di usia berikutnya. Tujuan penelitian ini untuk mengetahui perbedaan perkembangan pada bayi usia 6-11 bulan yang mendapat ASI eksklusif dan ASI non eksklusif di Puskesmas kecamatan kecamatan Durenan Trenggalek tahun 2017.Desain penelitian ini adalah studi inferensial dengan pendekatan cross sectional. Sampel yang diambil dalam penelitian ini adalah ibu dengan bayi 6-11 bulan pada bulan Oktober di Puskesmas kecamatan kecamatan Durenan Trenggalek pada tahun 2017 berjumlah 40 responden yang diambil menggunakan metode probability sampling dari jenis sistem simple random sampling. Data dianalisis dengan analisis univariat bahwa distribusi frekuensi variabel independen dan dependen dan analisis bivariat menggunakan Mann-Whitney U.Hasil penelitian menunjukkan bahwa dari 20 responden 95% yang mendapatkan ASI eksklusif memiliki perkembangan yang sesuai, 5% memiliki perkembangan yang meragukan, 0% mengalami gangguan perkembangan. Sementara 20 responden diberi 40% menyusui non eksklusif memiliki perkembangan yang sesuai, 60% memiliki perkembangan yang meragukan, dan 0% mengalami gangguan perkembangan. Hasil analisis statistik menunjukkan ada perbedaan perkembangan pada bayi usia 6-11 bulan yang mendapat ASI eksklusif dan ASI non eksklusif di Puskesmas kecamatan Durenan Trenggalek tahun 2017.Jadi dapat disimpulkan bahwa ada perbedaan perkembangan pada bayi usia 6-11 bulan yang mendapatkan ASI eksklusif dan ASI non eksklusif di Puskesmas kecamatan Durenan Trenggalek tahun 2017. Sehingga diharapkan bayi mendapat ASI eksklusif selama 6 bulan pertama dan dilanjutkan hingga 2 tahun dengan makanan pendamping (MP-ASI).Kata kunci : ASI eksklusif, ASI tidak eksklusif, pengembangan ABSTRACTDisorder of Infant growth in early life caused baby are given Complementary feeding (MP-ASI) too early and the mother didn’t give exclusive breastfeeding for 6 months in early life of baby. From the results of preliminary studies in infants aged 6-11 months who get non exclusive breastfeeding had almost entirely dubious developments. If this continues, the baby can’t develop properly in the next age. The purpose of this study to determine development differences in infants aged 6-11 months who get exclusive breastfeeding  and non- exclusive breasfeeding in community health center sub district Durenan Trenggalek district in 2017. The design of this study is inferential study with cross sectional approach.  Samples which taken in this study were mothers with infants 6-11 months in October in community health center sub district Durenan Trenggalek district in 2017 amounted to 40 respondents drawn using probability sampling method of the type system simple random sampling.  Data were analyzed by univariate analysis that the frequency distribution of independent and dependent variables and bivariate analysis using Mann-Whitney U. The results showed that of the 20 respondents 95% who get exclusive breastfeding had appropriate development, 5% had dubious developments, 0% had disorder development. While 20 respondents were given 40% non exclusive breastfeeding had appropriate development, 60% have dubious development, and 0% had disorder development. Statistical analysis showed there are differences development in infants aged 6-11 months who get exclusive breastfeeding and non-exclusive breasfeeding in community health center sub district Durenan Trenggalek in 2017. So can be concluded that there are differences development in infants aged 6-11 months who get exclusive breastfeeding and non-exclusive breasfeeding in community health center sub district Durenan Trenggalek in 2017.So expected the babies got exclusive breastfeeding for the first 6 months and continued to 2 years with complementary foods (MP-ASI).Key Words : exclusive breastfeding, non exclusive breastfeding, development


2018 ◽  
Vol 3 (3) ◽  
pp. 568
Author(s):  
Ainal Mardiah ◽  
Arni Amir ◽  
Andi Friadi ◽  
Ellyza Nasrul

<p><em>Iron deficiency anemia is anemia caused by iron deficiency in the blood. Maternal iron deficiency affects the low iron reserves in neonates </em><em>and it also influences on </em><em>Brain Derived Neurotropic Factor (BDNF) </em><em> which affects cognitive function.</em><em> </em><em>The purpose of this study was to determine the difference mean of BDNF in neonates from normal pregnant women and pregnant women with iron deficiency. </em><em>The design of this research was Cross Sectional</em><em> </em><em>design. This research was conducted in Community Health Center of Lubuk  Buaya, Ambacang Community Health Center, Community Health Center of Ikur Koto Health Center and Biomedical Laboratory of Andalas University on February 2017 to April 2018. There were 42 pregnant women was selected as sample e of this research. The samples were chosen by Consecutive Sampling. Then, the sample is divided into two groups: normal pregnant women and pregnant women with iron deficiency anemia. BDNF are examined by the ELISA. Next, the data were analyzed by using T test. The levels of BDNF neonates in normal pregnant group was 3.65(ng/ml) and the anemia pregnant group was 1.74(ng/ml) (p &lt;0.05). There was significant difference of BDNF levels in neonates from normal pregnant women and pregnant women with iron deficiency anemia. </em><em>The conclusion of this study is there is a difference of average BDNF in neonates from normal pregnant women and pregnant women with iron deficiency.</em></p><p> </p><p>Anemia defisiensi besi adalah anemia yang disebabkan karena kekurangan zat besi dalam darah. Defisiensi besi  maternal berdampak pada rendahnya cadangan besi pada neonatus dan berdampak terhadap ekspresi Brain Derived Neurotropic Factor (BDNF) yang berpengaruh pada fungsi kognitif. Tujuan penelitian ini adalah untuk mengetahui perbedaan rerata kadar BDNF pada neonatus dari ibu hamil normal dan ibu hamil defisiensi besi. Desain penelitian ini adalah Cross Sectional. Penelitian dilakukan di Puskesmas Lubuk Buaya, Puskesmas Ambacang, Puskesmas Ikur Koto dan Laboratorium Biomedik Universitas Andalas pada bulan Februari 2017 – Juli 2018. Sampel Penelitian adalah ibu hamil sebanyak 42 orang yang dipilih secara Consecutive Sampling, sampel dibagi menjadi dua kelompok yaitu ibu hamil normal dan ibu hamil anemia defisiensi besi. BDNF diperiksa dengan metode ELISA. Data dianalisa menggunakan uji T test. Kadar BDNF neonatus pada ibu kelompok normal adalah 3,65(ng/ml) dan kelompok ibu anemia adalah 1,74(ng/ml) (p&lt;0,05). Terdapat perbedaan bermakna kadar BDNF pada neonatus dari ibu hamil normal dan ibu anemia defisiensi besi. <em></em></p>


2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Robert C. Kaplan ◽  
Zheng Wang ◽  
Mykhaylo Usyk ◽  
Daniela Sotres-Alvarez ◽  
Martha L. Daviglus ◽  
...  

Abstract Background Hispanics living in the USA may have unrecognized potential birthplace and lifestyle influences on the gut microbiome. We report a cross-sectional analysis of 1674 participants from four centers of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), aged 18 to 74 years old at recruitment. Results Amplicon sequencing of 16S rRNA gene V4 and fungal ITS1 fragments from self-collected stool samples indicate that the host microbiome is determined by sociodemographic and migration-related variables. Those who relocate from Latin America to the USA at an early age have reductions in Prevotella to Bacteroides ratios that persist across the life course. Shannon index of alpha diversity in fungi and bacteria is low in those who relocate to the USA in early life. In contrast, those who relocate to the USA during adulthood, over 45 years old, have high bacterial and fungal diversity and high Prevotella to Bacteroides ratios, compared to USA-born and childhood arrivals. Low bacterial diversity is associated in turn with obesity. Contrasting with prior studies, our study of the Latino population shows increasing Prevotella to Bacteroides ratio with greater obesity. Taxa within Acidaminococcus, Megasphaera, Ruminococcaceae, Coriobacteriaceae, Clostridiales, Christensenellaceae, YS2 (Cyanobacteria), and Victivallaceae are significantly associated with both obesity and earlier exposure to the USA, while Oscillospira and Anaerotruncus show paradoxical associations with both obesity and late-life introduction to the USA. Conclusions Our analysis of the gut microbiome of Latinos demonstrates unique features that might be responsible for health disparities affecting Hispanics living in the USA.


2021 ◽  
pp. 1-20
Author(s):  
Asher Y. Rosinger ◽  
Anisha I. Patel ◽  
Francesca Weaks

Abstract Objective As tap water distrust has grown in the US with greater levels among Black and Hispanic households, we aimed to examine recent trends in not drinking tap water including the period covering the US Flint Water Crisis and racial/ethnic disparities in these trends. Design Cross-sectional analysis. We used log-binomial regressions and marginal predicted probabilities examined US nationally-representative trends in tap and bottled water consumption overall and by race/ethnicity. Setting The National Health and Nutrition Examination Survey data, 2011–2018. Participants Nationally-representative sample of 9,439 children aged 2-19 and 17,268 adults. Results Among US children and adults, respectively, in 2017-2018 there was a 63% (adjusted prevalence ratio [PR]:1.63, 95%CI: 1.25-2.12, p<0.001) and 40% (PR:1.40, 95%CI: 1.16-1.69, p=0.001) higher prevalence of not drinking tap water compared to 2013-2014 (pre-Flint Water Crisis). For Black children and adults, the probability of not drinking tap water increased significantly from 18.1% (95%CI: 13.4-22.8) and 24.6% (95%CI: 20.7-28.4) in 2013–14 to 29.3% (95%CI: 23.5-35.1) and 34.5% (95%CI: 29.4-39.6) in 2017–2018. Among Hispanic children and adults, not drinking tap water increased significantly from 24.5% (95%CI: 19.4-29.6) and 27.1% (95%CI: 23.0-31.2) in 2013-14 to 39.7% (95%CI: 32.7-46.8) and 38.1% (95%CI: 33.0-43.1) in 2017-2018. No significant increases were observed among Asian or white persons between 2013-14 and 2017-18. Similar trends were found in bottled water consumption. Conclusions This study found persistent disparities in the tap water consumption gap from 2011–2018. Black and Hispanics’ probability of not drinking tap water increased following the Flint Water Crisis.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaojingyuan Xu ◽  
Chunyan Zhao ◽  
Meirong Wang ◽  
Xiaolei Chen ◽  
Shuang Shao ◽  
...  

Abstract Background In an era of an increasingly ageing society, part of healthcare for older adults can be provided in patients’ homes, and the need for home health care services (HHCSs) is increasing. This study sought to determine whether a gap exists between the views of community health professionals and the caregivers of disabled older adults towards HHCSs in Beijing, China. Methods A cross-sectional study with two comparative questionnaire surveys was conducted in Beijing, China. One survey was administered to the caregivers of disabled older adults, and the other was administered to health professionals in community health service institutions (CHSIs). T-tests and Wilcoxon signed-rank tests were used to explore potential differences between the views of caregivers and community health professionals towards HHCSs. Results We received 370 valid questionnaires from caregivers and 224 questionnaires from health professionals. Of the 370 caregivers, 314 (84.9%) were willing to apply for HHCSs for the older adults, but only 20.5% (N = 76) received HHCSs. Over 80% of the caregivers accepted out-of-pocket costs less than 100 yuan per visit. Caregivers’ demands on home nursing services were significantly higher than those of health guidance services (Z = − 7.725, P < 0.001). Most of the 224 health professionals chose “health professionals’ personal safety cannot be guaranteed” as a problem limiting the provision of HHCSs (N = 151, 40.8%). The health professionals’ attitudes towards home nursing services were significantly less positive than those towards health guidance services (Z = − 10.081, P < 0.001). For home nursing services, health professionals’ attitude scores were lower than the caregivers’ demand scores (Z = − 4.960, P < 0.001), while for health guidance services, health professionals’ attitude scores were higher than the caregivers’ demand scores (Z = − 8.373, P < 0.001). Conclusions Gaps exist between the views of caregivers and health professionals on HHCSs. Compared to health professionals with a higher willingness to provide health guidance services, caregivers need home nursing services. Feasible policies should be implemented to safeguard the rights and interests of health professionals, and qualified health professionals should be trained for HHCSs.


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